tus, an opening in the diaphragm. It is cut off of the stomach and the stomach is then is moved up through the chest to the neck, where it is reconnected to the remaining esophagus. A temporary feeding tube is inserted and remains in place during recovery. tients to receive this care near home,” explains August. “In that case we work closely with community physicians so patients receive the best care in the setting that’s most appropriate for them.” Keeley tolerated the chemo well and was back on his route even before finishing the treatments. He opted for the earliest radiation appointment so he could deliver the mail afterward. ever upbeat, he says, “Having cancer has a plus side. I used to weigh 245 pounds; now I weigh 182. I eat whatever I want and never gain weight. I stick with small portions and sometimes have trouble swallowing. A few glasses of water helps get the food down. That’s the way it is now, and it’s fine with me.” Langenfeld explains that the surgery hinders a patient’s ability to eat. “The stomach becomes a conduit, keeping the food passageway intact. Food passes to the stomach via gravity, so it may take longer. We advise patients to eat smaller, more frequent meals, and most do well.” “Many of our gastrointestinal cancer patients have difficulty eating,” adds August. “It’s one of the reasons why a multidisciplinary approach is important, to be sure patients maintain a healthy weight. even when patients do well with their cancer, if we don’t stay on top of these other problems, quality of life is impacted.” N ow cancer-free, Patrick Keeley appreciates Post-surgery, Keeley’s recuperation wasn’t easy. The diarrhea showed no signs of abating, even becoming worse While Keeley’s weight was stable, his diarrhea continued. He finally found the answer from Rutgers Cancer Institute dietitian Kristin Waldron, RD, CSO, a member of the Gastrointestinal Oncology Program. “She thought it might be caused by my pancreas not digesting fats properly,” says Keeley. “I now take medication and the diarrhea is pretty much under control.” In late 2015 Keeley had another setback. He began experiencing seizures – both mild ones and a grand mal seizure that occurred while he was at work. “That scared the heck out of everyone and they called 911,” he says. Initially there were concerns that the cancer had spread to his brain, but tests ruled that out. The cause of the seizures remains unknown. He has been diagnosed with epilepsy and is under the care of a neurologist. Anti-seizure medication keeps the condition under control. Cancer-free now, nothing stops Keeley from his appointed rounds. His prognosis is good, says August: “While there’s always a significant risk of this cancer recurring, most recurrences occur within two years. He’s passed the two-year mark and is doing well. “What we do here is a team effort,” August adds. “It’s part of our culture at Rutgers Cancer Institute. As a member of this team, there’s nothing more satisfying than helping our patients.” I the small things in life, like tending to his roses. with the tube feedings. Shortly after returning home, he had a fit of coughing that damaged his throat incision. His neck and face swelled and he was rushed back to the hospital. “My face looked like a watermelon,” Keeley recalls. “It was so bad that a couple next to me in the examining area asked to be moved.” August says this problem is not uncommon, considering the major changes made to the digestive anatomy. “The stomach doesn’t like to be all the way up in the neck,” he explains. “And for many reasons, the esophagus does not heal very well. So there’s a risk of leakage from the incision. When that happens, we open it and let it heal on its own.” Gradually Keeley became strong enough to begin chemotherapy and radiation. Because Rutgers Cancer Institute is a 90-minute drive from his home, these services were provided in nearby Toms River, at Community Medical Center, an RWJBarnabas Health facility. “The medical and radiation oncologists at Rutgers Cancer Institute are an integral part of our team, but sometimes it’s advantageous for pa- 22 I Cancer Connection I Summer 2017 P HOTOS By: N ICK ROMAN eN KO